Healthcare Provider Details

I. General information

NPI: 1902783061
Provider Name (Legal Business Name): JORDAN TAYLOR MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

IV. Provider business mailing address

2628 WHIRLAWAY AVE
FLORENCE SC
29505-8720
US

V. Phone/Fax

Practice location:
  • Phone: 843-601-1900
  • Fax:
Mailing address:
  • Phone: 843-601-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number283254
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: